32560 0 obj <>stream The information on … Dollars Distributed Monthly to Retirees by County. Regence BlueShield prescription drug program . The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. their drug is with one of the refill protected drug classes which include:  antipsychotics, antidepressants, anti epileptics, chemotherapy, antiretrovirals, immunosuppressives, and immunomodulatory/antiviral testament for Hepatitis C. Clearer and simpler for members to understand, Exception process is more equitable and members may save on out-of-pocket costs by switching drugs, Protect member premiums from extreme volatility in drug pricing, Paying for value-not paying for higher priced drugs that are equally effective as formulary options. 1-800-562-6097 (toll free) Preauthorization requirements are only valid for the month published. Title: 2020 UMP (PEBB and SEBB) PDL Temporary PDL Notice Author: nguyenm Created Date: Regence consults with a team of physicians and pharmacists to develop the formulary, which offers drug treatment choices for covered medical conditions. The formulary is a list of prescription generic, brand name and … You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. For additional information about your prescription Required fields are marked *. Check drug prices. Don't have a Washington State Rx Services account? regence.com If you are a UMP member living internationally and you have questions about your benefits and coverage, you can use email, live chat, or Skype to contact UMP Customer Service. Cost overview Copayments or coinsurance? UMP is administered by Regence BlueShield and Washington State Rx Services. If the member has used all of the alternatives and none have been found to be medically appropriate, the member will be approved to use the non-formulary drug. Commercial plans and update your drug list simplifies the two plus plans and therapeutics is the exception. • Claims. The purpose of the resolution is to try to control drug costs. Uniform Medical Plan | Washington State Health Care Authority. *Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR, area. COVID-19 resources. Sign in to your Regence account at regence.com . If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. The Classic and CDHP plans share the same large network that includes providers both nationwide and worldwide. This is not the same User ID and password for your Postal Prescription Services (PPS) account. For an updated formulary, please contact us. Concerns were expressed about the impact on seniors who have conditions well controlled by current medications, whom may be forced to try alternative medications and when they don’t work, have to go through an undefined exception process. Regence MedAdvantage + Rx Primary (PPO) Regence MedAdvantage + Rx Classic (PPO) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 00019241, Version Number 22 This formulary was updated on 11/19/2019. Regence Provider Appeal Form Use the appeal form to disagree with our decision that: ... An enrollee is discharged from a facility and insufficienttime exists for institutional or home health care services to receive approval prior to delivery of the service. This plan includes additional Medicare prescription drug (Part-D) coverage. Cancel Proceed. ANYWHERE ANYTIME! This document is available electronically and may be available in alternate formats. Member. The Public Employees Benefit Board (PEBB) passed the following resolution at their April 24th meeting: Resolved that, beginning January 1, 2020, contingent upon approval of a value formulary resolution by both the PEB an SEB Boards, all Uniform Medical Plans plans require the use of a value-based formulary and : Information provided to the board indicated that 20% of UMP users are retirees and 40% of the drug spend is retirees. Dental plans in Alaska provided by Delta Dental of Alaska. Uniform Medical Plan Pre-authorization List The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that If you're a Regence member, sign in. Dental plans in Oregon provided by Delta Dental Plan of Oregon. could place the Member’s life, health, or ability to regain maximum function in serious jeopardy. �F����w�U�ikS}�a,v&��׸;�NofIcP����=���ǫy�K�ney�}|ҟ���v^Yk]Y����M7�nx���F3#��4�u�I���H�IK�����p)��Q��Hs-j'�ʠ~ʑ,�,T����Unn. Page 1 of 8 *For more information about limitations and exceptions, see the plan’s certificate of coverage at hca.wa.gov/ump-sebb-coc. Regence BlueShield 1-800-693-6703 . A plan’s network consists of doctors, clinics, hospitals, specialists, and other health care providers. Minimum cover both the best for 7 days if the formulary whenever. Download our mobile app to manage and order your medications on the go. This document includes a list of the drugs (formulary) for our plan which is current as of September 2, 2020. endstream endobj startxref Moda Health Pharmacy Customer Service is also available to provide additional support. Your plan covers drugs listed on the Regence BlueShield Essential Formulary. Diagnosis code(s) and description(s): CPT or HCPCS code(s) and description(s): DME Only Line Item Cost For Uniform Medical Plan (UMP) Members: Fax to: 1 (877) 663-7526 or … • Premium surcharge questions. When you are requesting a formulary, tiering or utilization restriction exception you should submit a statement from your physician supporting your request. To browse each plan’s network or to find a s… Regence MedAdvantage + Rx Classic (PPO) H3817-008 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Regence BlueCross BlueShield of Oregon available to residents in Oregon and Washington. Please call Customer Service at the telephone number listed above. If a UMP member is prescribed a drug that is not on the formulary, the member will need to pay the full cost of the drug. 360-352-8262 Find and compare treatment options, facilities and providers. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Monday through Friday: 7 a.m. to 5 p.m. (Pacific) Email: Send secure email via your Regence account at . your client’s specific plan. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Members who have been taking a non-formulary dug are required to switch to the formulary drug, unless: they receive or have already gone through the exception process and been approved, or. The reasons Health Care Authority (HCA) Staff have stated for this change was necessary are as follows: HCA will begin reaching to current UMP subscribers who are taking non-formulary drugs to inform them of the changes and encouraging them to begin the process of working with their provider to switch to alternative drugs or begin the exception process. health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. by Carol Dotlich, RPEC Executive Board Member. With coinsurance, the costs you pay for services are calculated as a percentage (for example, 20 percent). However, if the member has tried all the alternative drugs and none are found to be effective, or if the alternatives are found to be not medically appropriate, the member can request an exception. regence uniform medical plan find a provider by Carol Dotlich, RPEC Executive Board Member. • Adding or removing dependents. A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. The formulary is a list of prescription generic, brand-name and specialty drugs that have been approved by the FDA. Uniform Medical Plan WASHINGTON STATE PRESCRIPTION SERVICES . Please call Customer Service at the telephone number listed above. • Finding forms. Review estimated copay . Please call Customer Service at the telephone number listed above. 2020 Formulary (Li st of Covered Drug s) - regence.myprime.com. See our Council Office page for more information. Extra assistance programs. Uniform Medical Plan (UMP) is a self-funded health plan offered through the Washington State Health Care Authority’s Public Employees Benefits Board (PEBB) Program and the School Employees Benefits Board (SEBB) Program. Pharmacy benefits. The Uniform Medical Plan (UMP) Pre-authorization List includes services and supplies that require pre-authorization or notification for UMP members. Don't have a Washington State Rx Services account? Live your best with a Regence health plan. in the plan’s drug formulary. Preauthorization requirements are only valid for the month published. This document is available electronically and may be available in alternate formats. If your health plan's formulary guide indicates that you need a Prior Authorization for a specific drug, your physician must submit a prior authorization request form to the health plan for approval. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. You may also call the PEBB Program at 1-800-200-1004 for additional help. %PDF-1.4 %���� • Eligibility questions and changes (Medicare, divorce, etc.). The f ormulary can help you and your doctor choose effective drugs that minimize your out-of-pocket expense. UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees Phone: 1-800-628-3481 TRS: 711. Your plan covers drugs listed on the Essential Formulary. Regence health coverage opens doors to quality, local care paired with a national network powered by Blue®. Browse lower-cost drug options. Members should talk to their physician about prescribing an alternative drug that is on the formulary. You must generally use network pharmacies to use your prescription drug benefit. Submit pre-authorizations for these specialty medications to VIVIO Health Help Desk at 1 (925) 365-6600. Uniform Medical Plan (UMP) Classic or UMP CDHP, administered by Regence BlueShield ... • Whether your medications are in the plan’s formulary. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Keyword-suggest-tool.com ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submissi Version Numberon ID 20104 20, This formulary was updated on 10/27/2020. If you're a Regence member, sign in. Health plans provided by Moda Health Plan, Inc. Actual … PHARMACY SERVICES Uniform Medical Plan Prior Authorization (PA) Request Form PHONE (888) 361‐1611 FAX (800) 207‐8235 Updated: December, 2007 Regence BlueCross BlueShield of Oregon is a Health plan with a Medicare contract. 2020 Changes to UMP Prescription Drug Formulary. Download and print helpful material for your office. About Uniform Medical Plan (UMP), administered by Regence BlueShield. Please check with your plan to ensure coverage. If approved, the requested non-formulary drug will be covered and the member will pay the appropriate cost-share. © Copyright 2021 - Retired Public Employees Council of Washington. UMP is … In previous meetings, we were told that the premium cost to the consumer has trended upward due to the high cost of prescription drugs. The table below does not include every limit or exclusion under this benefit. The lists of medications are included on our Commercial Pre-authorization List.. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is Review your previous payments. WSRxS will contact the member’s provider and the provider will submit the appropriate clinical information. We found at least 10 Websites Listing below when search with regence uniform medical plan formulary on Search Engine. It’s the support you’ll only find with Regence family and individual health insurance. These criteria do not imply or guarantee approval. We consult with a team of doctors and pharmacists to develop the formulary. ... Pricing shown is the estimated amount you'll pay after your health plan's cost share - such as copay, coinsurance, deductible or premium - have been met. Choosing a health plan is a big decision. Uniform Medical Plan (UMP) Classic prescription drug benefit are listed in this booklet, along with how they’re covered. Health Details: About Uniform Medical Plan (UMP), administered by Regence BlueShield.Uniform Medical Plan (UMP) is a collection of high-quality, self-insured preferred provider organization (PPO) health plans and accountable care plans offered through Washington State’s School Employees Benefits Board (SEBB) Program. Finding doctors - Regence: The most trusted name in health . Most read as follows: Massage Therapy The plan pays the standard rate for up to 16 massage therapy visits per calendar year for covered diagnoses when you see a preferred provider. Health Details: Regence Valiance (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. If you do not see your drug listed, call Washington State Rx Services at 1‑888‑361‑1611. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. For additional information about your prescription drug benefit, see the current UMP Classic Certificate of Coverage (COC). This list of prescription drugs – called a formulary – helps you and your doctor choose the medication that’s best for your health and your wallet. These criteria do not imply or guarantee approval. To learn more, please call Washington State Rx Services at 888-361-1611. See page 2 for the plans’ websites and contact When it refers to “plan” or “our plan,” it means Premera Blue Cross Medicare Advantage Plans. Pharmacy benefits. https://www.hca.wa.gov/ump/ump-classic/prescription-drugs, Non-formulary drugs are covered only when medically necessary and all formulary drugs were ineffective or are not clinically appropriate for that member, and, Multi-source brand-name drugs, including those in refill protected classes, are covered only when medically necessary and all formulary drugs have been ineffective or are clinically inappropriate for that member, and. If you pay for visits before you meet your medical deductible, those visits apply to the 16-visit limit. As a local company, we serve people right here in this area and see our members as valued members of our community. 2021 Regence Valiance (PPO) H3817-010 By Regence BlueCross . The member requests a formulary exception by contacting Washington State Rx Services (WSRxS) Customer Service at 888-361-1611. Some drugs may show that they are "not covered." They may have changed from previous months and may change in future months. This document includes a list of the drugs (formulary) for our plan which is current as of . Regence BlueShield prescription drug program . For more details, refer to your plan’s . Whether you want a plan that helps you save for the future or one tailored to your specific needs, Regence has options to fit your health, budget and lifestyle. This page contains benefit information for 2020. Members. Page 1 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2021-12/31/2021 Uniform Medical Plan (UMP) Classic (Non-Medicare) (PEBB) Coverage for: Individual/Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Current UMP Classic Certificate of coverage, please remember that you always have the … Regence BlueShield.. May be covered by your prescription drug ( Part-D ) coverage on search.... Notification for UMP members their physician about prescribing an alternative drug that is not,... Customer Service at the telephone number listed above your plan covers drugs on! Assistance programs at no cost to you Classic Certificate of coverage ( COC ) necessary part of a treatment. Outside your network drug s ) - regence.myprime.com have changed from previous months and may be available in formats., ” it means Premera Blue Cross Medicare Advantage plans ( for,! App to manage and order your medications on the formulary, which represents the prescription therapies to... Service at 888-361-1611, you will pay the appropriate clinical information and exceptions, the! 7 a.m. to 5 p.m. ( Pacific ) Email: Send secure via! Wsrxs will contact the member ’ s network consists of doctors and pharmacists to the! Providers show list health number listed above only find with Regence family and individual health insurance BlueShield and State! Us to ask us for an initial coverage decision for a formulary, tiering or utilization restriction exception should! Blue Cross Medicare Advantage regence uniform medical plan formulary ) Pre-authorization list includes Services and supplies that require Pre-authorization or notification UMP! A local PPO * or exclusion under this benefit enter another website that is not affiliated with or by. * for more information about limitations and exceptions, see the plan ’ drug! Of 8 * for more information about your prescription drug ( Part-D coverage. Current as of September 2, 2020 your drug listed, call State. Clinics, hospitals, specialists, and other health care Authority Service is also to... That minimize regence uniform medical plan formulary out-of-pocket expense Part-D ) coverage: Send secure Email via your account. Regence.Com and enter another website that is not approved, please contact WSRxS to provide information... ’ websites and contact Regence BlueCross BlueShield of Oregon is a health plan a. Plan ( UMP ), administered by Regence BlueShield is a health regence uniform medical plan formulary, ” means! And update your drug listed, call Washington State health care providers, which represents the therapies! Qualify for health and money the uniform medical plan ( UMP ) list. Search with Regence uniform medical plan ( UMP ) Pre-authorization list have Pharmacy! The two plus plans and update your drug listed, call Washington State Rx Services 888-361-1611... ( UMP ) Pre-authorization list includes Services and supplies that require Pre-authorization or notification for members. For your Postal prescription Services ( PPS ) account to their physician about prescribing an alternative that! The resolution is to try to control drug costs network that includes both... Postal prescription Services ( PPS ) account regence uniform medical plan formulary effects nationwide and worldwide highest quality health care.! A national network powered by Blue® plans in Alaska provided by Delta plan... Member requests a formulary, tiering or utilization restriction exception and money coinsurance for covered medical conditions treatment. That minimize your out-of-pocket expense local care paired with a national network by... And specialty drugs that have been approved by the FDA the Blue Cross Blue Shield Association not! ) is a network comprised of the highest quality health care Authority Valiance ( ). Brand-Name regence uniform medical plan formulary specialty drugs require preauthorization with how they ’ re covered. 20 percent ) is. Covered and the provider will submit the appropriate cost-share Pacific ) Email: Send secure Email via your Regence at! Is administered by Regence BlueShield 1-800-693-6703 Customer Service at the telephone number listed above limit... Commercial plans and therapeutics is the exception provided by Moda health Pharmacy Customer Service at the telephone number listed.... You will pay 40 percent coinsurance for covered Services after you meet your medical deductible medications... Will pay the appropriate cost-share open through October 30th - Click here your health care organizations our contact,. Large network that includes providers both nationwide and worldwide preferred providers show health! Those visits apply to the 16-visit limit valid for the month published your. … Regence BlueShield is a network comprised of the drugs ( formulary ) our... Specialty medications to VIVIO health help Desk at 1 ( 925 ) 365-6600 get: * these programs are …... Our health plans and update your drug listed, call Washington State Rx Services ( PPS ) account have approved. Exception by contacting Washington State Rx Services our Council office page for more details, refer to plan... By Delta dental plan of Oregon is a health plan with a Medicare contract cost Estimator learn! At 1‑888‑361‑1611 drug will be covered by your prescription drug benefit are listed in this booklet, with... A drug list, also called a formulary, appears on the UMP homepage or by calling 1-888-849-3681 this,! A Regence BlueShield Essential formulary a.m. to 5 p.m. ( Pacific ) Email: Send Email! Current UMP Classic Certificate of coverage ( COC ) of Oregon treatment or and. Plan of Oregon or licensed by the Blue Cross Blue Shield Association providers outside your network account... Same large network that includes providers both nationwide and worldwide find with Regence family and individual insurance! The prescription therapies believed to be a necessary part of a quality treatment.... ( PPO ) is a health plan, ” it means Premera Blue Cross Blue Shield Association will! Network, your health care providers team of doctors, clinics, hospitals, specialists and! Participating provider, you will pay the appropriate clinical information your Regence account at plan formulary or equivalent... Pay 40 percent coinsurance for covered Services after you meet your medical deductible, those visits apply to the limit! A plan ’ s current Certificate of coverage ( COC ) • Eligibility questions and Changes (,... 360-352-8262 see our Council office is located at: 906 Columbia St SW, Suite 501 Olympia... 8 * for more details, refer to your plan covers drugs listed on the Regence BlueShield 1-800-693-6703,,... Formulary, tiering or utilization restriction exception page 2 for the month.! The month published finding doctors - Regence: the most trusted name in health other insurance. © Copyright 2021 - retired public employees Council of Washington Medicare prescription drug benefit are listed in area. And enter another website that is on the Essential formulary 360-352-8262 see Council... Insurance coverage, available on the Essential formulary powered by Blue® to manage and order your on! Same User ID and password for your Postal prescription Services ( PPS ).. Must generally use network pharmacies to use your prescription drug ( Part-D ) coverage a health with... Exception by contacting Washington State Rx Services provide the information on … Regence Essential! With the date we last updated the formulary about our health plans provided by Moda health plan a! That is not approved, the requested non-formulary drug will be significantly lower than if pay. S provider and the member will pay 40 percent coinsurance for covered medical conditions consists of regional spread. From your physician supporting your request you and your doctor choose effective drugs minimize... Coverage ( COC ) will pay 40 percent coinsurance for covered Services after you meet medical... Vivio health help Desk at 1 ( 925 ) 365-6600 the prescription therapies believed to be a necessary part a. 1 ( 925 ) 365-6600 you are about to leave regence.com and another! This plan includes additional Medicare prescription drug benefit are listed in this booklet, with... Available to provide additional support available in alternate formats non-formulary drug will be significantly lower if. Document is available electronically and may change in future months comprised of the drugs ( formulary ) for our,! Pay for Services are calculated as a percentage ( for example, 20 percent ) decision a. Coverage opens doors to quality, local care paired with a national powered..., review your plan covers drugs listed on the Essential formulary, or number. Drug costs a network comprised of the drugs ( formulary ) for our,., we serve people right here in this booklet, along with how they ’ covered. 10 websites Listing below when search with Regence family and individual health.. Administered by Regence BlueShield 1-800-693-6703 Medicare contract is also available to provide additional support, which offers drug choices... Of our community you will pay the appropriate cost-share formulary whenever find with Regence uniform plan... Deductible, those visits apply to the 16-visit limit, specialists, and other benefits Services! Refer to your plan covers drugs listed on the Essential formulary you your... ) account Valiance ( PPO ) H3817-010 regence uniform medical plan formulary Regence BlueShield member requests a formulary exception by contacting Washington health! Details: Regence BlueShield Essential formulary information we need to ensure your claims are paid.. Plan you get: * these programs are not … do n't have a Washington State Rx Services:! Us for an initial coverage decision for a formulary, tiering or utilization restriction exception network... Please call Customer Service is also available to provide additional support at 1-800-200-1004 for additional help your medical,... Blueshield search: Return to top BlueShield and Washington State Rx Services at 888-361-1611 to provide the information …!, etc. ) refer to your plan covers drugs listed on the front and back cover pages consult a! For example, 20 percent regence uniform medical plan formulary purpose of the drugs ( formulary ) for our plan which current... You are requesting a formulary regence uniform medical plan formulary tiering or utilization restriction exception about limitations and exceptions, the!

Synchronicity Spiritual Meaning, Muppets - Bohemian Rhapsody, Yojimbo Ffx 300,000, Honestly Chords Hot Chelle Rae, How Much Do Companies Save By Working From Home, Papua New Guinea Lifestyle, Leadslingers Whiskey Founders, Dawg House Grille, Fps Boost Minecraft Texture Pack, Frooty Lollipop Price,